Combining a Smartphone App With Medications to Manage Heavy Drinking
VA Office of Research and Development
Summary
One in 10 Veterans have an alcohol use disorder. However, few Veterans receive evidenced-based psychosocial interventions or medications to treat alcohol use disorder. Barriers to receiving these treatments include long wait times, stigma, and long distances from treatment facilities. Even fewer Veterans receive psychosocial and medication interventions together, despite clinical practice guidelines recommending both and evidence of better outcomes. Expanding access to these treatments in primary care is a VA priority but delivering psychosocial interventions is difficult in this setting, and medication is often the only option. Smartphone apps that deliver alcohol interventions may improve drinking outcomes and ensure Veterans can receive both treatments in primary care. This study will determine whether medications and an app for alcohol use problems offered to Veterans in primary care results in improved drinking outcomes, compared to Veterans receiving medications only. Study data will inform how to spread the app across the VA nationally.
Description
Background: Alcohol use disorder (AUD) affects 1 in 10 Veterans and is associated with significant morbidity and mortality. However, few individuals receive evidenced-based psychosocial interventions or medications for AUD (MAUD). Common barriers to treatment include long wait times, stigma, and distance from treatment facilities. Despite clinical guidelines and evidence indicating superior outcomes, even fewer individuals receive MAUD and psychosocial interventions conjointly. The VA prioritizes expanding access to AUD interventions in primary care, but it is difficult to deliver psychosocial…
Eligibility
- Age range
- 18–80 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: To be eligible, Veterans must be: * 1\) diagnosed with an AUD and report 4 HDD * (defined as 5 standard drinks per day for men and 4 standard drinks per day for women) in prior 30-days * 2\) enrolled in VA primary care * 3\) planning to initiate MAUD, as determined by a medication order * 4\) between ages 18-80 * 5\) willing to be randomized * 6\) Android or iPhone smartphone owners Exclusion Criteria: * 1\) past 30-day participation in VA or non-VA SUD treatment * 2\) prior episode of MAUD receipt in the last 30 days (initiation of a new episode of MAUD in the 7 day…
Interventions
- OtherStand Down mobile app
The Stand Down mobile app is a smartphone-based stand-alone intervention designed to help persons manage drinking and alcohol-related problems on their own. The app is based on principles of motivational enhancement and cognitive-behavioral therapies and comprises 7 modules organized around 4 goals: (i) Enhance awareness of drinking patterns (assessment and personalized feedback), (ii) Establish and monitor progress towards drinking goal - i.e., moderation or abstinence, (iii) Manage cravings and other problems using in-the-moment tools, and (iv) Connect users with other types of support.
- OtherStandard Care
Participants assigned to the standard care condition will receive standard MAUD care delivered by their CPSs and will not receive access to SD-App. Three medications, naltrexone, disulfiram, and acamprosate, have been approved by the Federal Drug Administration and topiramate has been recommended by the VA/DoD clinical practice guidelines for SUD. MAUD includes these four medications. All medication decisions will be between the CPS and the Veteran and not influenced by study participation.
Locations (15)
- Phoenix VA Health Care System, Phoenix, AZPhoenix, Arizona
- Veterans Health Care System of the Ozarks, Fayetteville, ARFayetteville, Arkansas
- Washington DC VA Medical Center, Washington, DCWashington D.C., District of Columbia
- North Florida/South Georgia Veterans Health System, Gainesville, FLGainesville, Florida
- Atlanta VA Medical and Rehab Center, Decatur, GADecatur, Georgia
- Carl Vinson VA Medical Center, Dublin, GADublin, Georgia